An Israeli research team has found that acupuncture may be able to help clear persistent warts by creating an anti-inflammatory immune response. Eighteen patients with persistent human papilloma virus-caused warts received either verum acupuncture or placebo treatment. Verum acupuncture was performed at Sanyinjiao SP-6, Zhangmen LIV-13, Kongzui LU-6, Zusanli ST-36, Shousanli L.I.-10, Yaoyangguan DU-3 and Zhongwan REN-12. Placebo treatment was performed with non-insertive needling at seven points on the back. Both groups received four treatment sessions, given at one-week intervals. Clinical success was defined as total clearance of all wart lesions with no recurrence for three months. In the treatment group, the clinical success rate was found to be 36.6 per cent, compared with zero per cent in the placebo group. Measurement of cytokine levels in participants’ blood suggested that acupuncture may cause a shift to a Th1–cell-mediated immune response, leading to an anti-inflammatory effect in the immunological microenvironment of the wart lesions, which promotes their resolution.

Investigators from Australia and New Zealand report that acupuncture treatment can reduce menstrual pain intensity, and that its effects can still be felt one year later. A randomised controlled trial was performed with 74 women randomly assigned to one of four treatment arms: low frequency manual acupuncture (LF-MA), high frequency manual acupuncture (HF-MA), low frequency electro-acupuncture (LF-EA) and high frequency electro-acupuncture (HF-EA). A clinical manual-based protocol was used to allow individualised treatment, with a maximum of seven points used per treatment and a total of 12 treatments performed over three menstrual cycles, either once per week (LF groups) or three times per week (HF groups), in the week prior to menstruation. All groups also received a treatment in the first 48 hours of their period. Acupuncture was found to reduce menstrual pain intensity and duration after three months of treatment, and this was sustained for up to one year after the start of the research. The mode of stimulation or frequency of treatment was not found to be significant, although the authors suggest that this may be due to a lack of statistical power. During the treatment period and nine month follow-up all groups showed statistically significant reductions in peak and average menstrual pain compared to baseline, but there were no differences between groups. Health-related quality of life increased significantly in six domains in groups with a high frequency of treatment compared to only two domains in low frequency groups. Manual acupuncture groups required less analgesic medication than electro-acupuncture groups. HF-MA was most effective in reducing secondary menstrual symptoms compared to both-EA groups.

The role of treatment timing and mode of stimulation in the treatment of primary dysmenorrhea with acupuncture: An exploratory randomised controlled trial. PLoS One. 2017 Jul 12;12(7):e0180177.

Three minutes of acupressure is effective in decreasing pain intensity due to acute musculoskeletal injury, report researchers from New Zealand. Seventy-nine athletes who sustained a sports-related musculoskeletal injury received three minutes of acupressure, sham acupressure or no acupressure. The acupressure group reported 11 mm less pain on average than the sham acupressure group, and 9 mm less than the control group as a result of the intervention.

Acupuncture can reduce pain and pathological thickness of the common extensor tendon (CET) in patients with lateral epicondylitis (LE). Ultrasound evaluation of the CET in a patient with LE may reveal increased tendon thickness, which correlates with the severity of the LE. Turkish clinicians randomly assigned 41 patients to acupuncture and control groups. All received conventional treatment, and the acupuncture group also received needling at six acupoints (an ashi point, Shousanli L.I.-10, Quchi L.I.-11, Chize LU-5, Hegu L.I.-4 and Weiguan SJ-5) for 25 minutes per session, two or three times a week for four weeks (a total of 10 sessions). Subjective pain and hand function scores improved in both groups, but pressure pain threshold and CET thickness only improved in the acupuncture group.

An American group has found that acupuncture can significantly and persistently reduce stress in university students and staff. Their study included 111 participants with high self-reported stress levels who either studied or worked at a large urban university. Participants were randomised into a verum or sham acupuncture group, and both groups received treatment once a week for 12 weeks.

The treatment group received needling at a predetermined set of points: Baihui DU-20, Yintang, Shanzhong REN-17, Qihai REN-6, unilateral Shenmen HE-7, Neiguan P-6, Hegu L.I.-4, LIV-3 and Zusanli ST-36, plus auricular points Shen Men, Liver, Point Zero and Heart. The control group received needling without manipulation at three non-acupuncture points. While participants in both groups showed a substantial initial decrease in perceived stress scores, at 12 weeks post-treatment the verum acupuncture group showed a significantly greater treatment effect than the sham group. This study indicates that acupuncture may be successful in decreasing the perception of stress in students and staff at a large urban university, and this effect persists for at least three months after the completion of treatment.

Effectiveness of Acupuncture Therapy on Stress in a Large Urban College Population. J Acupunct Meridian Stud. 2017 Jun;10(3):165-170.

The Acupuncture Now Foundation (a non-profit organisation dedicated to educating the public, healthcare providers and health policymakers about acupuncture) has submitted an extensive document to the Food and Drug Administration (FDA – the US government agency responsible for protecting and promoting public health). The 34-page position paper summarises the most pertinent information regarding the potential of acupuncture for treating common pain conditions and reducing dependency on harmful medications. They review the current body of research as well as providing an overview of the potential benefits and limitations of expanding acupuncture’s role in pain management. The paper contains up-to-date research summaries on chronic and acute pain, plus summaries of four landmark studies. The authors intend it to be a useful resource for those preparing evidence summaries to government agencies, health insurance companies and health policy decision-makers.

Acupuncture in Pain Management: Strengths and Weaknesses of a Promising Non-Pharmacologic Therapy in the Age of the Opioid Epidemic. 2017.

The largest-ever pragmatic randomised trial of acupuncture carried out in hospital emergency departments has found that it is a safe and effective alternative to pain-relieving drugs for acute pain. A total of 1964 patients presenting at four Australian hospital emergency departments with back pain, migraine and ankle sprain were randomised to acupuncture alone, acupuncture plus pharmacotherapy or pharmacotherapy alone. The results showed that although neither acupuncture nor standard pharmacotherapy afforded patients clinically relevant reduction in pain within an hour, patients still found both treatments to be acceptable, and the effectiveness of acupuncture alone was comparable with that of pharmacotherapy.

A systematic review by American authors also supports acupuncture as an effective treatment for acute pain in the hospital emergency department. Meta-analyses were performed on data from 14 randomised controlled trials (representing 1210 patients) which compared acupuncture with sham, acupuncture with standard analgesia and acupuncture as an adjunct to standard care. Acupuncture was judged to be more clinically effective compared to sham and non-inferior to conventional drug therapy for acute pain. Limited data was also found that indicated superior results if acupuncture was added as an adjunct to standard analgesia. Acupuncture was also associated with improved patient satisfaction, lower cost and fewer adverse effects.

Does acupuncture have a role in providing analgesia in the emergency setting? A systematic review and meta-analysis. Emerg Med Australas. 2017 Jul 26. [Epub ahead of print].

Acupuncture is still effective for pain relief a year after treatment has ended, according to a paper by Prof Hugh MacPherson and international colleagues from the Acupuncture Trialists’ Collaboration. Using a large individual patient data set from high-quality randomised trials of acupuncture for chronic pain (20 trials, including 6376 patients) the authors determined the trajectory of pain scores over time, after acupuncture for conditions including musculoskeletal pain (low back, neck, shoulder), osteoarthritis of the knee and headache. In trials comparing acupuncture to a no-acupuncture control, effect sizes diminished by a nonsignificant amount (0.011 SD per three months) after treatment ended. This suggests that approximately 90 percent of the benefit of acupuncture relative to controls would be sustained at 12 months. For trials comparing acupuncture to sham, they observed a smaller, but still significant, reduction in effect size (0.025 SD per three months), suggesting approximately a 50 percent diminution at 12 months. The authors recommend that studies of the cost-effectiveness of acupuncture should take these findings into account.

The persistence of the effects of acupuncture after a course of treatment: a meta-analysis of patients with chronic pain. Pain. 2017 May;158(5):784-793.

Acupuncture could be a viable alternative to medication for treating depression-related insomnia, report the authors of a meta-analysis from China. Eighteen randomised-controlled clinical trials with 1678 participants were analysed. The results showed that acupuncture treatment led to significant improvements in sleep scores compared with western medicine. Acupuncture combined with western medicine produced a better effect on sleep quality compared with western medicine alone. Acupuncture and western medicine improved depression scores by an equal amount, and acupuncture combined with western medicine was more effective than western medicine alone.
The Efficacy of Acupuncture for Treating Depression-Related Insomnia Compared with a Control Group: A Systematic Review and Meta-Analysis. Biomed Res Int. 2017;2017:9614810.

UK researchers examining economic data on 12 non-pharmacological interventions for osteoarthritis of the knee (KOA) have found acupuncture and transcutaneous electrical nerve stimulation (TENS) to be cost-effective. The authors applied network meta-analysis to data from 88 randomised controlled trials including 7,507 patients. They based their cost-effectiveness estimations on a threshold of £20–30,000 per QALY (quality-adjusted life year – a measure of disease burden used to assess the value for money of medical interventions), as this is used by the UK’s National Institute for Health and Care Excellence (NICE) to assess whether treatments represent a cost-effective use of UK NHS resources. When all trials were considered, TENS was found to be cost-effective at the NICE threshold, with an incremental cost-effectiveness ratio of £2,690 per QALY versus usual care (meaning one quality-adjusted life year would be gained for each additional £2,690 spent on TENS). When only higher quality trials were considered, acupuncture was found to be cost-effective (with an incremental cost-effectiveness ratio of £13,502 per QALY versus TENS). The authors further noted that, while acupuncture is not currently recommended by NICE as a treatment for KOA, based on their calculations some interventions that are recommended by NICE (insoles, braces and manual therapy) are unlikely to be cost-effective and therefore should not be prioritised for commissioning within the NHS.
Cost-effectiveness of adjunct non-pharmacological interventions for osteoarthritis of the knee. PLoS One. 2017 Mar 7;12(3):e0172749.